EVOLVE - MATERNITY UNCOMPLICATED
PREGNANCY EXAM ACTUAL EXAM 200
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES|ALREADY
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A 14-year-old emancipated minor at 22 weeks' gestation comes in for her second prenatal
examination. As she enters the examination room with her mother, she tells the nurse that she
does not want her mother present for the examination. What should the nurse say?
✓ Telling the mother, "I'm sorry, but I need to ask you to stay in the waiting area."
Which finding indicates the development of a complication resulting from the presence of
bilateral cephalhematomas?
✓ Skin color
What findings occur with supine hypotensive syndrome? (Select all that apply.)
✓ 2 Feeling of faintness
✓ 4 Increased venous pressure
✓ 6 Decreased systolic pressure
Immediately after the third stage of labor a nurse administers the prescribed oxytocin (Pitocin)
infusion. Why is this medication administered?
✓ To help the uterus contract
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Three weeks after a client gives birth, a deep vein thrombophlebitis develops in her left leg
and she is admitted to the hospital for bedrest and anticoagulant therapy. Which
anticoagulant does the nurse expect to administer?
✓ Continuous infusion of heparin
A local anesthetic (pudendal block) is administered to a client as second-stage labor begins.
For what side effect does the nurse monitor for the client?
✓ Decreased blood pressure
A 24-year-old client who has been told that she is pregnant is at her first prenatal visit. She is
5 feet 6 inches tall and weighs 130 lb. What should the nutrition plan regarding her daily
caloric intake include?
✓ 340 more calories during the second trimester
A primigravida at 34 weeks' gestation tells the nurse that she is beginning to experience some
lower back pain. What should the nurse recommend that the client do? (Select all that apply.)
✓ 1 Wear low-heeled shoes
✓ 4 Perform pelvic tilt exercises several times a day
A nurse who is caring for a mother and her newborn infant reviews their record. In light of the
data the record contains, what nursing intervention is required?
✓ Maternal rubella vaccination
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The nurse is interpreting the results of a nonstress test (NST) on a client at 41 weeks' gestation.
Which result after 20 minutes is suggestive of fetal reactivity?
✓ Two accelerations of 15 beats/min lasting 15 seconds
During labor the nurse encourages the client to void periodically. The nurse knows that an over
distended urinary bladder during labor can:
✓ Predispose the client to uterine hemorrhage after birth
A pregnant woman tells a nurse in the prenatal clinic that she knows that folic acid is very
important during pregnancy and that she is taking a prescribed supplement. She asks the
nurse what foods contain folic acid (folate) so she may add them to her diet in its natural form.
Which foods should the nurse recommend? (Select all that apply.)
✓ 4 Black and pinto beans
✓ 5 Enriched bread and pasta
What nursing action is the priority for a client in the second stage of labor?
✓ Promote effective pushing by the client
A nurse is teaching a client to care for her episiotomy after discharge. What priority
instruction should the nurse include?
✓ Perform perineal care after toileting until healing occurs.
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One hour after a birth a nurse palpates a client's fundus to determine whether involution is
taking place. The fundus is firm, in the midline, and two fingerbreadths below the umbilicus.
What should the nurse do next?
✓ Continue periodic evaluations and record the findings
At 5 am, 2 hours after a long labor and vaginal birth, a client is transferred to the postpartum
unit. What is the nurse's priority when planning morning care for this client?
✓ Planning nursing care activities that provide time for the client to rest and sleep
A nurse is being oriented to a prenatal clinic after graduation. The new nurse takes a course
on several tests during pregnancy. Place the tests in the order in which they should be
performed during pregnancy.
✓ 1 Sickle cell screening
✓ 2 α-Fetoprotein (AFP) testing for neural tube defects
✓ 3 Serum glucose for gestational diabetes
✓ 4 Fetal movement test
✓ 5 Group B Streptococcus culture
Which position does the nurse teach the client to avoid when she experiences back pain during
labor?
✓ Supine position
A postpartum client is being prepared for discharge. The laboratory report indicates that she
has a white blood cell (WBC) count of 16,000/dL. What is the next nursing action?
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